K10p

Name:

Date:

#	Question	Answer
1	About how often did you feel tired out for no good reason?	1 2 3 4 5
2	About how often did you feel nervous?	1 2 3 4 5
3	About how often did you feel so nervous that nothing could calm you down?	1 2 3 4 5
4	About how often did you feel hopeless?	1 2 3 4 5
5	About how often did you feel restless or fidgety?	1 2 3 4 5
6	About how often did you feel so restless you could not sit still?	1 2 3 4 5
7	About how often did you feel depressed?	1 2 3 4 5
8	About how often did you feel that everything was an effort?	1 2 3 4 5
9	About how often did you feel so sad that nothing could cheer you up?	1 2 3 4 5
10	About how often did you feel worthless?	1 2 3 4 5